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The growing population of adolescents and young people (AYP) aged 15 to 24 in sub-Saharan Africa face a high burden of HIV in many settings. Unintended pregnancies among adolescent girls in the region remain high. Nonetheless, the sexual and reproductive health (SRH) service needs of AYP have remained underserved. We conducted a cluster-randomised trial (CRT) to estimate the impact of community-based, peer-led SRH service provision on knowledge of HIV status and other SRH outcomes, including met need for contraceptives. Yathu Yathu was a cluster-randomised trial (CRT) conducted from 2019 to 2021 in 2 urban communities in Lusaka, Zambia. The communities were divided into 20 zones (approximately 2,350 AYP/zone) that were randomly allocated to the Yathu Yathu intervention or control arm. In each intervention zone, a community-based hub, staffed by peer support workers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15 to 24 were given a Yathu Yathu card, which allowed them to accrue points for accessing SRH services at the hub and health facility (intervention arm) or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive to use SRH services in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome: knowledge of HIV status (self-reporting living with HIV or HIV testing in the last 12 months) and secondary outcomes, including use of pre-exposure prophylaxis (PrEP) in the last 12 months, current use of antiretroviral therapy (ART), and met need for contraceptive services. The sampling was stratified on sex and age group, and we analysed data at cluster-level using a two-stage process recommended for CRTs with <15 clusters/arm. A total of 1,989 AYP consented to participate in the survey (50% male); consent was similar across arms (63% consent/arm). Across zones, knowledge of HIV status ranged from 63.6% to 81.2% in intervention zones and 35.4% to 63.0% in control zones. Adjusting for age, sex, and community, knowledge of HIV status was higher in the intervention arm compared to control (73.3% versus 48.4%, respectively, adjusted prevalence ratio (PR) 1.53 95% CI 1.36, 1.72; p < 0.001). By age and sex, results were similar. There was no evidence for impact on any secondary outcomes, including current use of ART and met need for contraceptives. There were no adverse events reported in either arm. A key limitation of our trial is that approximately 35% of the AYP randomly selected for participation in the endline survey could not be reached. Delivering community-based, peer-led SRH services increased knowledge of HIV status among AYP, both males and females, compared with the control arm. Scaling up the highly effective Yathu Yathu strategy has the potential to make a substantial contribution to increasing access to HIV prevention and care services for young people. However, additional implementation research is needed to understand how to improve uptake of broader SRH services, beyond uptake of HIV testing. ISRCTN75609016, clinicaltrials.gov number NCT04060420.

The article explores the state, causes, and effects of poverty in Malawi. It proceeds to investigate soteriology as a prominent theme in Dietrich Bonhoeffer’s theological thought. Then it explores how Bonhoeffer’s notion of salvation could be employed as paradigm to address the challenge of poverty in Malawi. The soteriological perspective is preferred, among many other approaches, for two reasons: the hamartiological origins of poverty require a soteriological exploration, and salvation is a prominent theme in Malawi. Approaching the social evils from the perspective of the doctrine of salvation could produce enduring effects. The observation is that such an approach could be more promising and could bear enduring fruits regarding addressing the challenge of poverty in Malawi.

Taenia solium cysticercosis is a neglected parasitic zoonosis occurring in many developing countries. Socio-cultural determinants related to its control remain unclear. Studies in Africa have shown that the underuse of sanitary facilities and the widespread occurrence of free-roaming pigs are the major risk factors for porcine cysticercosis. The study objective was to assess the communities' perceptions, practices and knowledge regarding latrines in a T. solium endemic rural area in Eastern Zambia inhabited by the Nsenga ethno-linguistic group, and to identify possible barriers to their construction and use. A total of 21 focus group discussions on latrine use were organized separately with men, women and children, in seven villages of the Petauke district. The themes covered were related to perceived latrine availability (absence-presence, building obstacles) and perceived latrine use (defecation practices, latrine management, socio-cultural constraints).The findings reveal that latrines were not constructed in every household because of the convenient use of existing latrines in the neighborhood. Latrines were perceived to contribute to good hygiene mainly because they prevent pigs from eating human feces. Men expressed reluctance to abandon the open-air defecation practice mainly because of toilet-associated taboos with in-laws and grown-up children of the opposite gender. When reviewing conceptual frameworks of people's approach to sanitation, we found that seeking privacy and taboos hindering latrine use and construction were mainly explained in our study area by the fact that the Nsenga observe a traditionally matrilineal descent. These findings indicate that in this local context latrine promotion messages should not only focus on health benefits in general. Since only men were responsible for building latrines and mostly men preferred open defecation, sanitation programs should also be directed to men and address related sanitary taboos in order to be effective.

Background Access to affordable and effective menstrual hygiene products (MHP) is critical to the menstrual health of adolescent girls and young women (AGYW). In this mixed-methods analysis, we use data from a programme delivering comprehensive sexual and reproductive health (SRH) services to describe access to MHP and how COVID-19-related closures affected access to MHP; we use qualitative data to understand AGYW’s experience accessing products during the study. Methods Between September 2019-January 2021, we used data routinely collected from ten Yathu Yathu hubs offering community-based, peer-led SRH services to adolescents and young people aged 15–24. Hubs offered free MHP (primarily disposable pads) as a service. To incentivise service access, a “loyalty” card system was embedded within Yathu Yathu, allowing individuals to gain points for services accessed and redeem rewards using these points. Branded pads, tampons and reusable pads were among available rewards. We describe access to service pads and to reward MHP, and use logistic regression to investigate factors associated with accessing pads and reward products before (Sept 2019-March 2020) and after (July 2020-Jan 2021) COVID-19-related closures. Focus group discussions explored accessibility of offering MHP through hubs. Results Between September 2019-January 2021, 6374 AGYW made 34,116 hub visits to access an SRH service and/or redeem a reward. At 30% of these visits, AGYW accessed any MHP. Before COVID19-closures, an average of 17% of monthly visits were for freely-available disposable pads compared to 34% after hubs reopened ( p  < 0.001). Results were similar for reward visits. Overall, 63% of 6374 AGYW collected pads as a service at least once. Prior to COVID19-closures, AGYW aged 18–24 were more likely to access service pads than adolescents (15–17-years). After reopening, access was lower among older AGYW. Prior to hub closures, uptake of reward MHP was higher among AGYW with some secondary education but not after reopening. Discussions revealed that, for adolescents aged 15–19, COVID-19-related hub closures required reverting to using ineffective materials to manage menstruation. Conclusion Availability of MHP through Yathu Yathu provided a large number of AGYW with access to these products. Hubs seemed particularly important for adolescent girls. Community-based, peer-led hubs should be considered as spaces to provide AGYW access to affordable and effective MHP.

Background In southern Africa, men are less likely than women to access HIV services, including HIV testing, antiretroviral therapy (ART), and HIV prevention services. As a result, men living with HIV are less likely to be virally suppressed and more likely to transmit HIV than their female peers. Using the socio-ecological model as a framework, we explored factors that influence men’s motivation and capability to access available HIV services, including how social norms and social networks influence men’s engagement with services, in Lusaka, Zambia. Methods We conducted seven focus group discussions (FGDs) with men and women in an urban community in Lusaka. Five FGDs were conducted with men; two with young men aged 20–24; two with men aged 25–35 and one with men aged 20–35. We conducted two FGDs with women, stratified by age 18–24 and 25–35. The total number of participants was 70. Data were coded and analysed thematically. Results Pervasive negative community narratives around HIV, negative social and gender norms, the influence of men’s social networks, including stigma related to a positive HIV test result and fear of social isolation, were among the key factors influencing men’s access to HIV services. For HIV testing, the organization and delivery of services in health facilities, including location of HIV testing, waiting times, and likelihood of being seen accessing services, dissuaded men from testing for HIV. In general, health facilities were seen as women’s spaces and unresponsive to men’s needs. However, provider-initiated initiatives, including couples testing in antenatal care and an offer of HIV testing prior to medical male circumcision, and community-based HIV testing facilitated service use. Though condoms were the primary HIV prevention tool mentioned by study participants, norms of their use in marriage and sexual relations limited use. Conclusions Despite HIV having evolved to a chronic condition and various HIV prevention tools available, fear, social isolation, stigma, and harmful gender norms continue to negatively impact men’s motivation and capability to engage with available HIV services. Measures to facilitate men’s use of these services should consider how to increase social support alongside the delivery of services in spaces that meet men’s needs.

BackgroundToxoplasmosis is a zoonotic parasitic disease caused by Toxoplasma gondii (T. gondii). It has a wide host range and is capable of vertical transmission in pregnant women, which may lead to undesirable pregnancy outcomes such as congenital malformations, miscarriage, premature birth and stillbirth. This study investigated the seroprevalence of T. gondii infection among pregnant women attending the antenatal clinic at Namwala District Hospital in Southern Zambia.MethodsThis was a cross-sectional study where blood was collected, and the serum was tested for Toxoplasma IgG and IgM. A questionnaire was administered to participants on demographic characteristics and risk factors. Data were entered in Microsoft Excel and exported to STATA version 14 for analysis.ResultsA total of 401 women were enrolled in the study from 3 March to 5 August 2021. The seroprevalence of Toxoplasma IgG was 4.2% (n=17), while the seroprevalence of Toxoplasma IgM was 0.7% (n=3). The median age was 27 (IQR: 24–30) years, and a larger proportion had primary-level education (n=223, 55.6%). The majority (81.6%) of the women were married. None of the risk factors investigated in this study were significant for T. gondii infection.ConclusionThere was a low seroprevalence of T. gondii infection among pregnant women in the Namwala district of Southern Province, Zambia, and regular screening may not be warranted in this population. Continued research on toxoplasmosis is recommended to understand its epidemiology across Zambia.

Organic agriculture is still in its early development stage in Nigeria. As a result, its awareness and participation are still in development. Hence, the study identified factors influencing awareness, adoption, and quantity produced of organic green leafy vegetables, tomatoes, and peppers in Ekiti and Oyo states of Nigeria. A multistage sampling technique was employed to sample 384 vegetable farmers. Primary data was collected using a structured survey questionnaire instrument. The data was analysed using the triple hurdle model, which consists of three stages of decision-making. Probit was used to model the first and second stages of the triple hurdle for awareness and adoption, respectively. The third stage for adoption intensity was modelled using log–log multiple regression. According to the findings, farmers who were members of cooperatives and received extension services were more likely to be aware of and adopt organic vegetables. However, the use of radio was lowly used to promote organic agricultural awareness. On the other hand, the amount of labour used, and total revenue increased the quantity of organic vegetables produced. As a result, we conclude that the use of extension agents was pivotal in engineering the development of organic farming in Nigeria. Therefore, establishing an organic information hub would be an appropriate strategy for increasing awareness, adoption, and intensity in organic green leafy vegetable, tomato, and pepper production. This would help foster extension activities, and information transfer, as well as connect producers with buyers.

Introduction: Proteus species are frequently isolated from urinary tract infections (UTIs) and diabetic foot infections (DFIs). We aimed to evaluate the presence of virulence genes in P. mirabilis and P. vulgaris strains isolated from DFI and UTI. Methodology: A total of 78 Proteus isolates (57 P. mirabilis and 21 P. vulgaris) collected from patients were studied. The isolates were identified using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometer. The presence of virulence-associated genes (hlyA, mrpA, atfA, pmfA, hmpA, ptaA, ureA, ureC, zapA, ireA, rsbA, flaA, and ucaA) was evaluated by polymerase chain reaction (PCR). Results: 46 isolates were obtained from wound cultures, and 32 were obtained from the midstream urine cultures. All virulence genes, except hlyA, were detected in the study. ureA was the most detected gene in both UTI (100%) and DFI isolates (84.8%). The distributions of ureC, flaA, hpmA, ireA, rsbA, pmfA, zapA, ucaA, ptaA, atfA, and mrpA genes in DFI and UTI isolates were as follows: 82.6% and 96.9%, 71.7% and 93.8%, 69.6% and 93.8%, 69.6% and 96.9%, 69.6% and 96.9, 67.4% and 81.3%, 65.2% and 43.8%, 54.3 and 71.9%, 34.8% and 96.9%, 26.1 and 93.8%, and 23.9% and 46.9%, respectively. Conclusions: We demonstrated that P. mirabilis and P. vulgaris express a variety of virulence genes related to pathogenicity. All virulence genes were found to be more frequent in UTI isolates except zapA. There is limited data on the virulence factors of Proteus species in DFIs. Further studies are needed to investigate virulence genes in wound isolates.

Adolescents and young people aged 15–24 are underserved by available HIV-testing services (HTS). Delivering HTS through community-based, peer-led, hubs may prove acceptable and accessible to adolescents and young people, thus increasing HIV-testing coverage. We used data from the pilot phase of a cluster-randomised trial of community-based sexual and reproductive health services for adolescents and young people in Lusaka, Zambia, between September 2019 and January 2020, to explore factors associated with uptake of HTS through community-based hubs. 5,757 adolescents and young people attended the hubs (63% female), among whom 75% tested for HIV (76% of females, 75% of males). Community-based hubs provided HTS to 80% of adolescents and young people with no history of HIV-testing. Among females, uptake of HTS was lower among married/cohabiting females; among males, uptake was lower among unmarried males and among individuals at risk of hazardous alcohol use. The high number of adolescents and young people accessing hubs for HIV testing suggests they are acceptable. Enhanced targeting of HTS to groups who may not perceive their HIV risk needs to be implemented.

Antenatal vaginal progesterone (VP) reduces the risk of preterm birth (PTB) in women with shortened cervical length, and we hypothesize that it may also prevent PTB in women with HIV as their primary risk factor. We conducted a pilot feasibility study in Lusaka, Zambia to investigate uptake, adherence, and retention in preparation for a future efficacy trial. This was a double-masked, placebo-controlled, randomized trial of 200mg daily self-administered VP suppository or placebo. Pregnant women with HIV who were initiating or continuing antiretroviral therapy were eligible for participation. Potential participants underwent ultrasound to assess eligibility; we excluded those ≥24 gestational weeks, with non-viable, multiple gestation, or extrauterine pregnancies, with short cervix (<2.0cm), or with prior spontaneous PTB. Participants initiated study product between 20-24 weeks of gestation and continued to 37 weeks (or delivery, if sooner). The primary outcome was adherence (proportion achieving ≥80% study product use), assessed by dye stain assay of returned single-use vaginal applicators. Secondary outcomes with pre-defined feasibility targets were: uptake (≥50% eligible participants enrolled) and retention (≥90% ascertainment of delivery outcomes). We also evaluated preliminary efficacy by comparing the risk of spontaneous PTB <37 weeks between groups. From July 2017 to June 2018, 208 HIV-infected pregnant women were eligible for screening and 140 (uptake = 67%) were randomly allocated to VP (n = 70) or placebo (n = 70). Mean adherence was 94% (SD±9.4); 91% (n = 125/137) achieved overall adherence ≥80%. Delivery outcomes were ascertained from 134 (96%) participants. Spontaneous PTB occurred in 10 participants (15%) receiving placebo and 8 (12%) receiving progesterone (RR 0.82; 95%CI:0.34-1.97). Spontaneous PTB < 34 weeks occurred in 6 (9%) receiving placebo and 4 (6%) receiving progesterone (RR 0.67; 95%CI:0.20-2.67). In contrast to findings from vaginal microbicide studies in HIV-uninfected, non-pregnant women, our trial participants were highly adherent to daily self-administered vaginal progesterone. The study's a priori criteria for uptake, adherence, and retention were met, indicating that a phase III efficacy trial would be feasible.